Unsafe operation of multidisciplinary clinical meetings
First to latest report 10 Jan 2014 — 27 May 2026
Reports that mention this concern
33
Times this concern has been raised
38
Stated actions linked to this concern
32
What this concern includes
Includes failures of explicitly multidisciplinary clinical meetings, ward rounds, CPA meetings or comparable clinical case meetings involving inadequate preparation, relevant-record review, appropriate attendance, patient participation, risk discussion, decision-making, meeting effectiveness or recording where these impair safe care decisions.
What is not included
Excludes non-clinical, governance, learning or administrative meetings unless the assertion directly concerns a multidisciplinary clinical meeting about a patient's care.
Excludes generic communication, staffing, training or documentation deficiencies that are not directly tied to the operation of a multidisciplinary clinical meeting.
Excludes failures of a separately named clinical pathway or safety system where meeting operation is only an incidental component and the wider named concern provides the appropriate boundary.
Excludes inappropriate treatment, discharge or referral decisions where no deficiency in the multidisciplinary clinical meeting is identified.
Trends
Reports over time
Reports mentioning this concern, over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Department of Health and Social Care8
NHS England7
Essex Partnership University NHS Foundation Trust3
HM Prison and Probation Service3
Greater Manchester Mental Health NHS Foundation Trust2
Leicestershire Partnership NHS Trust2
Ministry of Justice2
Recipient name withheld2
Alternative Futures Group Limited1
Birmingham and Solihull Mental Health NHS Foundation Trust1
British Transport Police1
Browning Street Surgery1
Care Quality Commission1
Central and North West London NHS Foundation Trust1
Colchester Hospital1
NHS trust24
Ministerial department12
Executive non-departmental public body7
Executive agency3
Healthcare site3
Integrated care board3
Private limited company2
Type not available2
Company limited by guarantee1
Domiciliary care provider1
Health and care professional regulator1
Health and social care service regulator1
Prison or young offender institution1
Special police force1
Workplace safety regulator1
Reports and published responses 33 reports
See individual reports that have raised this concern, and the actions taken in response
Essex
Concerns raised1
Lack of multidisciplinary crisis planning meetings
This report raised 18 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
Essex Partnership University NHS Foundation Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Essex Partnership University NHS Foundation Trust
Use Dynamic Support Register and Care and Treatment Review referral processes to coordinate enhanced community support and alternatives to hospital admission.
North London
Concerns raised1
Failure to hold a multidisciplinary risk discussion for an unsafe home birth
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
Department of Health and Social Care
National Institute for Health and Care Excellence
NHS England
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
NHS England
Set minimum standards for safe homebirth services, including clear terminology, safety and risk assessment, multidisciplinary care planning, consent documentation, and standardised equipment.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.4
National Institute for Health and Care Excellence
The NHS Trust should consider support and consent matters because they concern local NHS delivery rather than requested national guidance.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
National Institute for Health and Care Excellence
Professionals must address alternative care when NICE recommendations are not followed in the specific circumstances.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
National Institute for Health and Care Excellence
Support under the Royal College of Midwives guideline falls outside NICE’s remit because NICE did not produce that guideline.
Outside remitThe respondent said that this matter was outside its role or authority.
Department of Health and Social Care
Responsibility for the specific homebirth concerns sits with NHS England, which will issue the substantive response.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Cheshire
Concerns raised1
Failure to enable named-nurse participation in MDTs
This report raised 13 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
Alternative Futures Group Limited
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Alternative Futures Group Limited
Implement MDT scheduling that enables named-nurse attendance or requires an appropriate alternative clinician to attend and prepare with the patient.
Alternative Futures Group Limited
Record named-nurse or alternative-clinician MDT attendance and monitor compliance through monthly senior-practitioner audits.
Essex
Concerns raised1
Failure of the multidisciplinary team meeting to discuss the patient's case
This report raised 7 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
East Suffolk and North Essex NHS Foundation Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
East Suffolk and North Essex NHS Foundation Trust
Enable Epic to auto-populate the next morning trauma list from referrals to reduce manual list-entry errors.
Essex
Concerns raised1
Failure of internal multidisciplinary joint working
This report raised 13 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
Essex Partnership University NHS Foundation Trust
HCRG Care Group
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.6
HCRG Care Group
Establish and staff a dedicated Early Days in Custody Nurse role to oversee reception screening, risk assessment, information sharing, escalation, supervision, and quality assurance.
HCRG Care Group
Provide structured reception-nurse supervision, coaching, documentation audits, case-based feedback, and governance reporting to improve recording and escalation of mental-health risks.
HCRG Care Group
Review mental-health operational procedures and referral processes to clarify urgent-referral thresholds, escalation routes, and expected 24-hour response times.
Essex Partnership University NHS Foundation Trust
Standardise sample-based community mental health caseload audits across localities.
Essex Partnership University NHS Foundation Trust
Reissue mandatory escalation guidance and introduce MDT agendas and case-presentation templates for changing risk or uncertainty.
Essex Partnership University NHS Foundation Trust
Require teams to record cases needing MDT discussion and require team leaders to review compliance weekly.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Essex Partnership University NHS Foundation Trust
Existing supervision, MDT escalation, governance, and proportionate sample-based audits are considered sufficient; exhaustive case-by-case auditing is not required.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Nottinghamshire
Concerns raised1
Lack of an embedded mechanism for cross-sector MDT meetings and liaison in foreign-body cases
This report raised 11 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
Nottinghamshire Healthcare NHS Foundation Trust
Sherwood Forest Hospitals NHS Foundation Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Nottinghamshire Healthcare NHS Foundation Trust
Trial a joint physical and mental health policy for managing patients who insert foreign bodies, including joint meetings and impact review.
Sherwood Forest Hospitals NHS Foundation Trust
Implement and approve a new guideline for managing deliberately inserted foreign bodies, including clear MDT and mental-health consultation requirements.
Essex
Concerns raised1
Lack of a specialist renal consultant at the MDT
This report raised 12 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
Mid and South Essex NHS Foundation Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Mid and South Essex NHS Foundation Trust
Operate a focused weekly kidney and upper-tract urological cancer MDT reviewing relevant recent scans with specialist multidisciplinary participation across hospital sites.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Mid and South Essex NHS Foundation Trust
Specialist renal consultant participation and cross-site hybrid MDT working are considered to have addressed concerns about decision-making and hospital interaction.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Birmingham and Solihull
Concerns raised1
Failure to convene a multidisciplinary meeting to coordinate the biopsy pathway
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Linked response
University Hospitals Birmingham NHS Foundation Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
University Hospitals Birmingham NHS Foundation Trust
Require bedside Infection Service reviews for complex pressure ulcers and multidisciplinary discussion with ward and Tissue Viability teams, escalating appropriate osteomyelitis cases to the complex bone MDT.
Inner North London
Concerns raised1
Failure to provide a Consultant Histopathologist at Hepato-pancreato-biliary MDT meetings
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
Department of Health and Social Care
NHS England
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Department of Health and Social Care
NHS England should further address concerns about consultant histopathologist attendance at meetings and national vacancies.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
NHS England
Trusts, rather than NHS England, are responsible for ensuring safe staffing levels in hospitals’ current day-to-day operations.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Essex
Concerns raised1
Failure to conduct multidisciplinary discussion of changes in presentation
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.